UTSA-UTHSC union seen as road to Tier One status

Mike Howell, By Melissa Ludwig - Express-News :
March 30, 2010

Faculty cite collaboration as one of the main advantages to having a combined university and medical center. At. UCSD, scientists from all departments can use the StarCAVE to project different models and images they are working with in a 3-D chamber.

Mansour El-Kikhia, president of the faculty senate at UTSA, told a panel of scholars studying the possibility of a merger that the faculty members at his school do not support the idea, but are not opposed to taking their relationship with the health science center to the next level.

Ben Amaechi, chairman of the health science center's faculty senate, declined to comment. But El-Kikhia said those educators are squeamish as well.

Like newlyweds, the institutions have "two different personalities," El-Kikhia said. "Over time, you develop your own way of living together, you develop a new culture, but you are still different. It is the same thing with us. It is going to take time."

But some politicians and community leaders say the time is now, and that a merger may be the "game changer" needed to fuel San Antonio's bid for a top national research institution.

"If San Antonio wants a first-tier institution, I would say the only shot we have got in the next generation is to figure out how to make that merger," said Dick Howe, a retired UTSA engineering professor.

The UT board of regents has appointed a seven-member panel to study a merger, headed by former UTSA and UT-Austin President Peter Flawn. The panel is expected to deliver its findings to regents in June.

Professors and administrators at institutions in Texas, California and Maryland say a combined medical school and university can be both boon and burden. Melding two distinct cultures is tough; managing them both is a nightmare.

But some wonder if Texas ever will be able to compete with other states if it does not consolidate its universities and medical institutions, which historically have remained independent.

Most of California's nine Tier One research universities include medical schools, which amass much larger budgets and greater research capacity than standalone universities.

"Reputation-wise, just by combining the two funding (streams), you will go up in the rankings," said David Brenner, UCSD's vice chancellor for health sciences and dean of the medical school. Beyond that, the institutions share "synergies that would surprise you," he said.

In his opinion, San Antonio's health science center is considered average, with a few areas of real strength.

"It's down the list on the pecking order," Brenner said. "They would need to do something dynamic and brave to get to the next level."

Could that something be a merger with UTSA?

"I think it could be," Brenner said.

Different animals

Many in San Antonio don't agree, including prominent businessmen and donors such as B.J. "Red" McCombs and Tom Frost.

"For the life of me, I can't see why that is any advantage to either one of those schools," McCombs said.

Critics cite the cost of integrating business operations, as well as a cultural gap between the campuses.

But it's unclear whether total integration would be necessary, or even desirable. Even when attached to universities, health science centers tend to steer their own ship, often maintaining separate computer systems, human resources policies and salary structures, administrators say.

"In both places, the medical center was in my opinion self-sustaining," Black said. "We really did not go to the chancellor for anything."

Some institutions, such as UCSD, own their teaching hospital; others forge partnerships, like the UT Health Science Center and the public, taxpayer-supported University Health System.

That relationship is far more crucial than any link to the general university, administrators said. Medical centers often contribute a bit to university programs; conversely, if the medical school plunges into debt or the hospital fails, the university is on the hook. But when things are well-managed, there is no major financial gain or loss associated with the partnership, administrators said.

The medical center, however, is always the "800-pound gorilla in terms of size of budget," Black said.

At UCSD, for instance, 36 percent of the combined $2.5 billion budget comes from medical center and medical group revenues. Around 33 percent comes from grants and contracts, the majority attracted by health sciences faculty.

Only 9 percent comes from student fees, and 12 percent from state appropriations.

Money generated by patient care goes back into patient care, Brenner said. But the university and the medical center share maintenance and security, a theater, gyms, sports fields and a student union.

The medical students "love it here," Brenner said. "They really feel like they are part of an integrated campus." The institution also shares an endowment, which cuts down on turf wars over philanthropic gifts, Brenner said.

"The biggest problem, if (the merger) ever came to pass, is that medical schools are unique outfits. People who have gone through medical training sit on one side of the street and the university sits on the other side," said John Kastor, a medical professor at the University of Maryland who has written books about the governance of teaching hospitals. "University presidents don't know how to deal with medical complexes."

Would William Henrich, president of the health science center, report to Ricardo Romo, president of UTSA? Or would it be the other way around?

The cultural divide extends to faculty members, often characterized by a general feeling of superiority on the medical side. Doctors make a lot more money than do history professors; however, they're expected to generate income for the institution by seeing patients and landing research grants.

If they perceive their institution's brand is degraded by a merger, the strong ones will leave.

"The faculty of a medical school is an entirely different animal," said Kenneth Ashworth, former Texas commissioner of higher education. "They are much more spoiled."

'The rich get richer'

Merging medical institutions has been tried - and often failed - but few medical schools have merged with a university.

Baylor College of Medicine in Houston recently tried to merge with Rice University after losing its hospital partner in 2004 and plunging into debt. Leaders at Rice insisted the medical school would have to mop up its own financial mess, but the deal fell through.

"I think it is going to be very difficult for Baylor," Black said. "I don't know how they are going to make it."

Joining UTSA and the health science center would be far less complicated, said state Sen. Leticia Van de Putte, D-San Antonio, who has been pushing the merger idea for years.

Both schools are on solid financial footing and already are governed by the same board of regents in Austin. The state doles out money differently to medical campuses than to universities, but Van de Putte said UT could figure out how to tweak the formula.

"They are all under the same mother ship," Van de Putte said.

Kent Hance, chancellor of the Texas Tech University System, presides over an emerging research university and medical school in Lubbock, and is competing with UTSA in the race for Tier One status. If San Antonio merges, he would seriously consider doing the same.

"If it would be advantageous for UTSA, then it would be advantageous for us," Hance said.

The greatest benefit is the research collaborations and joint programs that flow from a combined institution.

"Binding people together not by discipline, but by a common project, is the trick to success," said David Cheresh, a pathology professor at UCSD. "Not only do you get people more enthusiastic, it brings in more revenue. Bigger projects get done."

Cheresh, who has no use for academic silos or ivory towers, has rounded up a diverse team of surgeons, chemists, engineers and biologists to help develop a new drug that uses nanoparticles to stop cancer from metastasizing. Like targeted bombing, the nanoparticle finds the tumor, delivers the payload and spares the normal tissue, Cheresh said.

"People are attracted to this place because of the scientists," Cheresh said. "It's sort of like the rich get richer."

An arranged marriage

Collaborations also are blossoming between UTSA and the health science center, but that's a recent development.

Consultants for UT previously studied a merger in 2002 - again at Van de Putte's urging - and concluded the two institutions had only just begun warming up to one another.

"It seemed ridiculous to me that we had these two campuses where the presidents tolerated each other, but were acting like little silos," Van de Putte said.

In the last legislative session, she and other lawmakers funneled $8 million to the San Antonio Life Sciences Institute, a joint venture for collaborative research projects. The two institutions also run a joint graduate program in biomedical engineering, and students take classes and conduct research on both campuses.

But political pressure can't force scientists to work together, and much of the progress to date is due to UTSA's increased recruiting of respected scientists. Slapping the two institutions together on paper will not automatically result in greater collaboration, or an instant Tier One research institution, critics say.

"You don't make a first-rate university that is not first rate by adding a medical school," Kastor said.

In San Antonio's case, it is tricky because the two institutions did not grow up together like UCSD, and must awkwardly court each other as adults. And it doesn't help that faculty seem ambivalent about their potential mate.

But in Van de Putte's view, critics need to look beyond the walls of their own institution and the borders of Texas to get in the national game. A merger would give the institution a combined budget of more than $1 billion and annual research spending of $250 million, numbers that at least put it in the ballpark.

And hey, even some arranged marriages grow loving over time.

"We live in interesting times and everything is possible," Van de Putte said. "We just need people to not be complacent and give the excuse that this is the way we have always done it. Our students deserve better and our taxpayers deserve better."